Professor Ciarán O’Boyle – Director, RCSI Centre for Positive Psychology and Health
It has always seemed to me that we go through life largely unaware of the defining impact of our pre-suppositions on our attitudes, beliefs, and actions. The philosopher of science, Thomas Kuhn in his book “The Structure of Scientific Revolutions” defined such pre-suppositions as paradigms and he was particularly insightful about the impact of paradigms on science – “Scientists, just like the rest of humanity, carry out their day to day affairs within a framework of pre-suppositions, called a paradigm, about what constitutes a problem, a solution and a method. At any given time, a particular scientific community will have a prevailing paradigm that shapes and directs work in the field. People become overly attached to their paradigms and scientific revolutions always involve intellectual bloodshed.”
Since Descartes separated “soul” from “body” in Western thought, the prevailing paradigm in medicine has been the biomedical model. This has proven very useful in dealing with such conditions as infections, broken bones, cancer tumours and blocked arteries. In this paradigm the body is a machine and the job of the “healthcare” system is largely to fix it when it gets damaged or broken. However, the biomedical model, and its associated approach to healthcare, is not so good as a foundation for understanding and intervening in highly complex systems that include biological, psychological and sociological factors. The burgeoning of lifestyle diseases in developed developing countries points to the limitations of a downstream, resource intensive, curative approach and highlights the additional need for upstream preventive strategies. According to the World Health Organisation, taken together, five conditions – diabetes, cardiovascular diseases, cancer, chronic respiratory diseases, and mental health disorders – account for an estimated 86% of the deaths and 77% of the disease burden in the European Region. The WHO estimates that 80% of heart disease, stroke and type 2 diabetes and 40% of cancer could be prevented, primarily through improvements in diet and lifestyle
In July of this year, the McKinsey Global Institute reported that, using interventions that already exist today, the global disease burden could be reduced by about 40 percent and active middle age extended by 10% over the next decades. Over 70 percent of the gains could be achieved from prevention by creating cleaner and safer environments, encouraging healthier behaviours, and addressing the social factors that lie behind these, as well as broadening access to vaccines and preventive medicine. McKinsey estimates that that better health could add $12 trillion to global GDP in 2040, far more than implementation costs. Furthermore, the social benefits of improved health would far exceed the economic benefits, estimated to be approximately $100 trillion by 2040.
The RCSI Centre for Positive Psychology and Health
I have spent most of my working life in the RCSI University of Medicine and Health Sciences. The institution was founded in 1784 originally to train surgeons but has, over the years, developed into the world’s number one university for impact on wellbeing and health (Times Higher Education World University 2020 Rankings). After much consideration we are launching, this month, a new Centre for Positive Psychology and Health to undertake research and provide education to equip people to develop their resilience and optimise their health and wellbeing.
Among the drivers for a quite traditional institution such as ours to develop such a centre are the following:
- Scientific understanding of the complex interactions between brain, mind and body is growing. For example, findings relating to the gut-brain axis, neuroplasticity and brain changes associated with behaviours such as meditation, the possible central role of metaflammation as a mediator of environmental, psychological and behavioural factors in disease, and advances in lifestyle, integrative and personalised medicine all point to new ways of thinking about the complex systemic functioning of humans in health and disease.
- Science knows a great deal about human misery. We have decades of research on depression, anxiety, and stress but very little on states such as well-being, happiness, love, hope, optimism, resilience and psychological growth. The emergence of the scientific discipline of positive psychology over the last 20 years points to the possibility of science being able to contribute not only to the amelioration of mental illness in a minority of the population but to the optimisation of happiness and well-being in everyone.
- Public interest and appetite for reliable positive health education is high and growing. In the last 24 months, we have engaged with over 2 million people via our public health lecture series. In an information age, institutions such as ours have a responsibility to provide the public with authoritative, evidence-based information that enables them to make the best health related choices for themselves and their families. We need to foster an educational osmosis in which our medical schools are more open and more accessible, not only to our students, but to everyone.
- New research has shown that positive education, where the focus is not only on academic development but also on the development of resilience and character, has a significant impact on the mental health of children and young people. This, in turn, improves academic performance. Early development of resilience may go a long way to ameliorating the growing prevalence of mental health problems in young people. At RCSI, we have adopted a positive education strategy as the foundation of our new medical school curriculum.
- One of the positive impacts of the dreadful COVID pandemic is that it has made us much more aware of the importance of health. Not only that, but it has increased our understanding of the impact of our individual decisions and actions in managing the risk to ourselves and others. This may serve to increase the salience of public health in general and to increase people’s acceptance of the positive and negative role their own behaviours can play in relation to the development of lifestyle diseases. Where I live, I see more people walking and cycling than ever before and the rapid development of cycle-ways and pedestrianised streets demonstrates how relatively small changes in the environment can benefit lots of people. When roads slim down, people do too.
- The COVID pandemic, and its associated “infodemic”, have also created significant challenges to our mental health. This is particularly true for frontline workers but it is also the case for the population as a whole. Preventive and palliative psychological interventions have been shown to be effective not only in reducing psychological distress but in fostering post-traumatic growth.
- The COVID pandemic is changing the nature of work, possibly for ever. Organisations struggling to modify their workplaces and create virtual workplaces face numerous challenges in optimising the health and well-being of their employees while maintaining productivity. As we increasingly move to knowledge based economies, the organisations that can deploy new virtual management and leadership strategies to create positive workplaces that optimise the health and well-being of their people are the organisations that will survive and thrive.
I regularly find myself returning to the definition of health underpinning the work of the World Health Organisation – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Science and evidence-based health care is moving beyond disease care delivered exclusively in the hospital or clinic to include the active preservation and enhancement of health by people in their homes, schools, and workplaces. The healthcare system of the future will combine new technologies with a preventative approach that is predictive, personalised, and participatory and focused on total health.
To quote Plato, “The part can never be well unless the whole is well”
Professor Ciarán O’Boyle
Director, RCSI Centre for Positive Psychology and Health
Ciaran’s articles for health professionals on the psychological aspects of COVID-19 can be found here: https://www.rcsi.com/dublin/coronavirus/healthcare-professionals/leadership
and general advice for the public here:
https://www.rcsi.com/dublin/coronavirus/information-for-the-public/positive-mental-health
